The Use of Three-Dimensional Printing in Cardiac Structural Disease: A Review

Abstract

Objective: Three-dimensional printing (3DP), or additive fabrication, is a process in which a physical 3D model is created using a multitude of 2-dimensional images. This process has been applied to numerous surgical subspecialties with growing interest for the use of 3DP in adult structural heart disease. This scoping review evaluates the use of 3DP in transcatheter and surgical aortic and mitral valve interventions as well as left atrial appendage occlusion in terms of its practical and clinical application. Methods: Articles were identified through PubMed and Embase using MeSH search terms as well as independent searches. A total of 645 articles were screened, and 37 were retained for qualitative analysis. Results: Operative planning was coded in 100% of articles, complication prevention in 43%, medical education in 5.4%, patient education in 0%, and simulation in 5.4%. Conclusions: The main uses of 3DP in acquired structural heart disease are centered around operative planning and complication prevention, with moderate use regarding surgical simulation and infrequent use regarding medical and/or patient education. Although patient anatomy varies greatly, deploying 3DP as a large-scale tool remains a possibility. The more 3D models are made, the more can be learned about demographic subsets of patient populations. Due to the lack of standard operating procedures for the creation of 3DP models, the cost-effectiveness of these models is hard to determine and likely center specific. More research into this facet could inform centers that wish to implement this tool.

Left atrial appendage occlusion: On the need of a numerical model to simulate the implant procedure

“…The support of numerical tools leads to an even more patient‐centric intervention and allows for improvement and prediction of procedural outcomes. In this light, positive impacts on the patient's health can be obtained 15–23 …”

“…In this light, positive impacts on the patient's health can be obtained. [15][16][17][18][19][20][21][22][23] Namely, only two studies focusing on the device deployment phase are reported in the literature, given the fact that most of the computational investigations are devoted to the left atrium hemodynamics before, [24][25][26] or after the LAA closure. [27][28][29] As regards computational structural modeling of LAAO, the platform developed by FEOPS company (HEARTguide) based on finite element analyses (FEA) has been recognized as a medical device and suggested as a valid planning tool for comparing different possible LAAO procedures (i.e., positioning of the access/delivery system with respect to the LAA ostium) and selecting the most effective in terms of safe outcomes (no DP into the atrium, good device apposition on the LAA wall and complete LAA occlusion).…”